NEW YORK -- As President Bush gives his State of the Union speech Monday, there will be one man in the audience who plans to sit quietly and watch, his very presence a form of protest.

Joseph Libretti, 51, is sick. He has been diagnosed with chronic lung disease since volunteering after Sept. 11, 2001, to cut through steel to remove bodies from the gritty, smoking pile of detritus of the World Trade Center. Now, too weak to return to his job as an ironworker, he mostly keeps close to his Pennsylvania home.

He is among a group of responders demanding a coherent national program to provide local medical treatment for Ground Zero workers from outside New York City who answered the call to help after the terrorist attacks. An existing program was effectively halted in December, when the federal government canceled its search for a contractor to process medical reimbursements.

"The president should take care of the workers," Libretti said during a telephone interview in which he frequently coughed and lost his breath. "If he sees me and other first responders, he'll know we're there."

His protest was helped by Rep. Carolyn B. Maloney (D-N.Y.), who has made medical care for Ground Zero workers her cause.

"What kind of a nation are we?" Maloney said. "What kind of a message are we sending to future responders? 'You are rushing into tragedy, and we are not going to be there.' "

Right now, Libretti's son regularly drives him two hours to Manhattan to consult with a pulmonologist and a psychiatrist at Mount Sinai Medical Center, which runs a program providing comprehensive treatment to first responders who suffer from some common ailments: cough, asthma, headaches, nosebleeds, other respiratory ailments and post-traumatic stress disorder.

People came from all 50 states to help in rescue, recovery and cleanup at Ground Zero, and the federal government had been searching for a contractor to run a business center to manage their health care since then. The center would help clinics across the country treat and monitor first responders, streamline existing payment and pharmaceutical plans, and pay medical bills.

On Dec. 13, the Centers for Disease Control and Prevention canceled a request for proposals to establish the business center. Without the center, there would be no entity to offer medical referrals to responders far from New York City, or any single scheme for the government to reimburse their doctors or to streamline pharmaceutical reimbursements.

James Melius, an occupational health specialist who is the chairman of the steering committee of the World Trade Center Medical Monitoring and Treatment Program, said the center is critical because funding to treat and monitor the health of first responders across the country is about to expire.

The Red Cross is providing limited funding to treat about 500 first responders outside the New York City area, but that will end in coming months, while another contract for monitoring about 2,000 people will run out in June, Melius said.

"These people will basically be on their own," he said.

Bernadette Burden, a spokeswoman for the CDC, said the contractor request was canceled because its language was unclear and confusing.

"We wanted to review the requirements," she said, "to make certain this solicitation was accurate and fair and to make a determination as to whether a new solicitation should be issued in the future."

Funding was uncertain, and there was little interest in filling the contract, added Holly Babin, a spokeswoman for the Department of Health and Human Services.

But Congress had already appropriated $50 million for treating and monitoring first responders, and it approved another $108 million shortly after the contract was called off, Rep. Maloney said.